Despite the urgent rise in adolescent opioid overdoses, overdose prevention remains underrepresented in pediatric medical education. Medical school offers a critical window to embed this crucial form of prevention through the intentional training of future physicians.
In a first-of-its-kind national survey, Nitin Vidyasagar and colleagues conducted a national cross-sectional survey evaluating U.S. pediatric clerkships for the inclusion of opioid overdose prevention education. Among the 85 academic institutions surveyed, they found that only 63% included any strategies to discuss overdose prevention education; fewer than 10% provided instruction on medications for opioid use disorder (MOUD); and less than 5% provided naloxone or fentanyl testing kits. This study highlights a major opportunity to better arm future physicians with both knowledge and practical skills to prevent adolescent overdose.
This research is especially urgent given the widespread proliferation of illicit fentanyl, which has magnified the U.S. overdose crisis. Between 2019 and 2021, adolescent overdose death rates increased by 109% overall, including an 182% rise in deaths involving illicit fentanyl. Similarly, pediatric opioid-related hospitalizations have substantially increased over the past two decades.
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These trends are particularly concerning given that adolescent overdose deaths continue to increase even as rates of illicit substance use are declining in this population. Despite these trends, routine clinical encounters with adolescents remain a largely untapped point of intervention. Given the scale of the pediatric overdose crisis, medical students must receive early and consistent training on how to screen for substance use and engage in overdose prevention during pediatric encounters.
To support the integration of overdose prevention content into the pediatric clerkship curriculum, it would be beneficial for U.S. medical schools to begin training students on overdose prevention education during both the pre-clinical and clerkship years. Pre-clinical curricula can benefit from the incorporation of standardized patient encounters that train students to screen for substance use, assess overdose risk, and deliver harm reduction counselling. Embedding overdose prevention in simulation-based activities has been shown to improve their clinical documentation skills, motivational interviewing capabilities, harm reduction knowledge, and use of non-stigmatizing language surrounding opioid use disorder (OUD).
During clerkships, integrating opioid overdose prevention into clinical learning offers a pragmatic strategy. The University of California, San Francisco, offers a compelling model through its Inter-Professional Approach to the Treatment of Opioid Use Disorder course. This program, piloted during pediatric clerkships, combines didactic sessions on harm reduction, simulations focused on effective counselling of adolescents who use substances, and hands-on training in naloxone administration. Delivered through both lecture and small group discussions, the course enables medical and nursing students to analyze real cases collaboratively, fostering an interprofessional approach to addiction care. Evaluations indicate that students emerge with greater confidence and compassion in managing patients with substance use disorders. By equipping medical students with these skills early and reinforcing them longitudinally through the clerkship years of medical training, medical education can play a critical role in preparing future physicians to respond effectively to the escalating crisis of adolescent opioid overdoses.
As opioid overdoses continue to rise in adolescent and youth populations, the classroom will likely become a critical setting for prevention. Through the embedding of education into pediatric clerkships and beyond, it will provide future doctors the tools to spot risk, intervene early, and practice medicine that doesn’t just treat but also prevents.
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Imeth Illamperuma is an undergraduate student at McMaster University studying Kinesiology with a Secondary in Psychology and a Certificate in Rehabilitation Science. He has extensive experience in public health research and policy advocacy, drawing experience from Stanford University, the Centre for Addiction and Mental Health (CAMH), and McMaster University. His work focuses on a plethora of topics including harm reduction, mental health, and the integration of artificial intelligence in clinical decision-making. His work is anchored in a commitment to preventative care and health equity, guided by research that drives real-world impact. Imeth is the Founder and President of SHIELD and the Founder of The Naloxone Project, one of the largest student-led University based emergency naloxone implementation and advocacy initiatives in Canada.
Suhanee Mitragotri is an incoming medical student at UC San Diego School of Medicine and a graduate of Harvard College, where she studied Neuroscience with a Secondary in Global Health and Health Policy. She is also the Co-Founder of the Naloxone Education Initiative, a program that aims to expand opioid and naloxone education to youth. She has written extensively on topics related to the opioid crisis, harm reduction, and drug policy and has published articles in various journals and magazines, including The Lancet Regional Health Americas, Addiction, Health Affairs Forefront, The Boston Globe, and New Scientist.
David T. Zhu is a third-year MD/PhD candidate in Health Policy at Virginia Commonwealth University School of Medicine. His research focuses on substance use disorders, pharmacoepidemiology, health economics, and social determinants of health. His work has been published in leading journals, including The Lancet, The Lancet Regional Health Americas, JAMA Internal Medicine, JAMA Network Open, JAMA Psychiatry, Nature Scientific Reports, BMJ Injury Prevention, and Harm Reduction Journal. David’s contributions to addressing the overdose crisis have been recognized by multiple foundations, including The Diana Award, the Boston Congress of Public Health’s 40 Under 40 in Public Health, the National Minority Quality Forum’s 40 Under 40 Leaders in Minority Health, and the U.S. Public Health Service’s Excellence in Public Health Award.
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